Journal of the American College of Surgeons
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Venous thromboembolism (VTE) prophylaxis has become routine for patients undergoing most operations, but it remains controversial for breast operations due to a perceived low risk of VTE. There is limited evidence to support routine or extended VTE prophylaxis in breast surgery. We investigated the benefits and risks of the Caprini risk stratification tool and corresponding prevention program, including extended prophylaxis for high-risk groups, in patients undergoing operations for benign and malignant breast lesions. ⋯ The Caprini protocol can identify high-risk breast surgery patients who may benefit from extended VTE chemoprophylaxis, as well as low-risk patients who require no chemoprophylaxis. Furthermore, administration of extended chemoprophylaxis was not associated with an increased risk of bleeding.
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Despite the presence of highly reliable data, studies on packed red blood cells (pRBC):fresh frozen plasma (FFP) ratio suffer from limited sample size and the presence of survivor bias. We sought to study the association between FFP:pRBC and early mortality in the hemorrhaging trauma patient. ⋯ A 1:1 FFP:pRBC ratio is associated with the lowest mortality in the hemorrhaging trauma patient, and mortality increases with decreasing ratios.
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Although physician health promotes retention to the profession and encourages higher-quality patient care, residents can face challenges seeking routine medical care. Erratic working hours, time constraints, easy access to informal health consultation, and a culture of self-reliance can deter help-seeking behavior. Despite national focus on physician burnout and efforts to promote wellness, little is known about the self-care habits of residents. The goal of this study was to evaluate the routine healthcare practices of resident physicians. ⋯ Despite a high prevalence of self-reported depression and prescription medication use, a significant proportion of surveyed resident physicians in New England do not seek mental health resources and lack consistent, routine healthcare. Resident health is vital to the mission of physician well-being and mitigating the escalating problem of burnout. Barriers to self-care and help-seeking behavior should be evaluated to promote sustainable behavior that will encourage a long professional career.
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Postoperative complication (POC) adversely impacts long-term survival in patients with gastric cancer, perhaps due in part to lower rates for receipt of multimodality therapy (MMT). We sought to determine the impact of POC on MMT completion rates and overall survival (OS) in patients with locally advanced gastric cancer. ⋯ Major POC adversely affects long-term survival after gastrectomy for gastric cancer, at least in part via lower completion rates of MMT. Treatment strategy designed to ensure the completion of MMT, such as TNT, might be preferable, particularly for patients at high risk for POCs.
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Surgeons are prone to feelings of sadness, guilt, and anxiety when involved in major adverse events. We aimed to create and evaluate a second victim peer support program for surgeons and surgical trainees. ⋯ We successfully designed, implemented, and assessed the impact of the first surgery-specific peer support program in the US. Our 1-year experience suggests that the program is highly used and well received, albeit with opportunities for improvement.